Project Summary: The 1999 Institute of Medicine report, To Err is Human, identified the emergency department (ED) as the area of the hospital with the highest risk of adverse events. The overall goal of this project is to decrease and mitigate the effects of medical error in a pediatric emergency department through the implementation of a multidisciplinary, simulation-based safety curriculum that emphasizes team behaviors. This type of training has proven effective in improving communication and teamwork in other high risk industries. All care providers, including residents, in a pediatric ED will participate in this intervention. [unreadable] [unreadable] Knowledge and attitudes will be assessed prior to and following the intervention. In addition videotapes of simulated patient scenarios will be assessed for change in teamwork behaviors. ED personnel will return for reassessment in the simulation lab every 6 months and actual resuscitations in the ED will also be videotaped and assessed for teamwork behaviors. This project is unique in its setting, a pediatric ED, and its inclusion of all care providers as well as residents in training. The specific aims of this application are: 1.To implement a multidisciplinary simulation-based safety curriculum that encompasses crew resource management, teamwork behaviors and critical communication skills. 2. To evaluate the effectiveness of this curriculum by assessing knowledge of and attitudes towards patient safety among caregivers prior to and following this intervention. 3. To evaluate the effectiveness of this training by assessing teamwork behaviors in a simulated setting prior to and following the intervention. 4. To evaluate the transfer of the skills learned in a simulated setting to the ED environment by evaluation of teamwork skills in actual critical emergency department patients. [unreadable] [unreadable] Relevance: The emergency department is one of the most dangerous areas of the hospital. In one study of adult emergency medicine claims, teamwork failures accounted for almost half the cases. The purpose of this project is to improve teamwork and communication skills among staff and physicians in a pediatric ED by having the ED teams learn and practice these skills with a pediatric patient simulator in a simulated ED. By improving teamwork and communication skills among caregivers, the care of critically ill and injured pediatric patients will be improved and safer. [unreadable] [unreadable]